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What Is Anal Cancer?

Anal cancer is an uncommon malignancy that starts in the anus -- the opening at the end of the rectum.

The American Cancer Society estimates that just 6,230 new cases of anal cancer are expected to occur in 2012 in the U.S. with just 780 expected deaths.

By way of contrast, more than 40,290 new cases of rectal cancer are projected for 2012.

Approximately half of all anal cancers are diagnosed before the malignancy has spread beyond the primary site, whereas 13% to 25% are diagnosed after the cancer has spread to the lymph nodes, and 10% are diagnosed after the cancer has spread to distant organs, that is metastasized.

When it is found early, anal cancer is highly treatable.

The overall five-year survival rate following diagnosis of anal cancer is 60% for men and 71% for women.

When the cancer is diagnosed in its earliest stage, five-year survival rate is 82%. Once the cancer has spread to surrounding lymph nodes, the five-year survival drops to 60%. If the cancer has spread to distant organs, about one in five patients lives for five years or more.

Who Gets Anal Cancer?

Most anal cancers (80%) are diagnosed in people who are over the age of 60. Prior to age 35, anal cancer is more common in men. However, after age 50, anal cancer is slightly more common in women.

The incidence rate of anal cancer is six times higher in single men as compared to married men.

Receptive anal intercourse is strongly related to the development of anal cancer.

Anal infection with human papillomavirus (HPV) resulting in genital warts is a major risk factor for the cancer.

Immunocompromised patients, such as those with HIV disease, are prone to get anal cancer. In this subgroup, the prognosis is worse, than for non-immunocompromised patients.

Gardasil, the HPV vaccine originally approved for the prevention of cervical cancer, was approved for the prevention of anal cancer in late 2010.

What Are the Symptoms of Anal Cancer?

The most common symptom associated with anal cancer is bleeding.

Because anal itching can also be a symptom of the cancer, many people initially attribute their bleeding and itching to hemorrhoids. This can delay the diagnosis of anal cancer.

Other signs and symptoms of anal cancer may include:

  • Pain or pressure in the anal area
  • Unusual discharges from the anus
  • Lump near the anus
  • Change in bowel habits

How Is Anal Cancer Diagnosed?

Anal cancer nay be detected during a routine digital rectal exam or during a minor procedure, such as removal of what is believed to be a hemorrhoid.

The cancer may also be detected with more invasive procedures such as an anoscopy, proctoscopy, or endorectal ultrasound.

If cancer is suspected, a biopsy should be done and the specimen examined by a pathologist.

Staging workup should include an abdominal and pelvic CT scan or a pelvic MRI scan to assess the pelvic lymph nodes, a chest x-ray, and liver function studies. PET scanning is not necessary.

How Is Anal Cancer Treated?

Anal cancer is primarily treated with a combination of chemotherapy and radiation. This reduces the need for a colostomy and carries a 5-year survival rate of over 70%. The treatment of anal cancer, in this fashion, has not changed since 1974.

Surgery is reserved only for patients failing the above therapy. Salvage therapy has resulted in a 60% 5 year survival rate.

WebMD Medical Reference

Reviewed by Arnold Wax, MD on May 07, 2012

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